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Urology > Male urological disease > Flashcards

Male urological disease Flashcards

1
Q

Causes and Medical conditions associated with erectile dysfunction? (formative Q)

A
  • Age
  • Neuropathic causes (diabetes, alcohol excess, multiple sclerosis)
  • Vascular insufficient (atheroma, Coronary Artery disease)
  • Dyslipidaemia
  • Hypogonadism
  • Trauma
  • Drugs (b-blockers, thiazide diuretics)
  • Psychosomatic (stress, anxiety)
Medical Conditions associated with it:
• Diabetes mellitus
• CVD: MI, HTN
• Liver disease and alcohol
• Renal failure
• Trauma - Pelvic fracture
• Iatrogenic - Prostatectomy 75%
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2
Q

1st line and alternative Tx and Mx for erectile dysfunction

A
  1. PDE-5i (1st line) - sildenafil, tadalafil
  2. Other Tx (2nd line)
    - Intraurethral suppository
    - Intracavernosal injection
    - Vacuum assisted device
    - Shockwave therapy
  3. Psychotherapy is psychological problems are present
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3
Q

How does PDE-5i work? what are its SE and CI?

A

(1. ) Elevates cGMP levels in vascular smooth muscle cells of the corpus cavernosum
(2. ) Causes vasodilation, inc blood flow, penile erection
(3. ) Inform pt about a sustaining erection (priapism) that may occur for more than 4hrs, and if get pain to go visit specialist.
(4. ) CI = If taking GTN as causes severe hypotension

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4
Q

What is prostatitis? Clinical Features? Ix? Tx?

A

(1.) Common urological dx in men <50y. Inflammation of prostate. Bacterial prostatitis = caused by infection/UTI (e.coli common).

(2. ) Sx:
- abdo, perianal, groin pain
- painful ejaculation
- acute onset of LUTs (frequency, dysuria, difficulty passing, poor stream).
- systemic sx: fever, chills, malaise

(3. ) Ix
- Urinalysis
- Urine, blood, semen culture

(4. ) Tx:
- Bacterial = 4-6w Abx, Quinolone

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5
Q

What is BPH? Patho? RF?

A

(1. ) Very common in men over 50y.
(2. ) BPH/BPE arises from smooth muscle hyperplasia of transitional zone
(3. ) This compresses urethra and causes BOO so we see LUTS (voiding and storage sx) associated with BOO
(4. ) It does NOT inc risk of prostatic cancer.
(4. ) RF = >50y, Fx, non-asian, smoking

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6
Q

i

A

i

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7
Q

3 Clinical features of BPE

A

(1. ) LUTS
(a. ) Voiding Sx: weak stream, dribble, dysuria, straining
(b. ) Storage Sx: frequency, urgency, nocturia, and incontinence

(2.)AUR: as unable to micturate, develop painful & distended bladder

(3. ) Following may also be present:
- Haematuria
- Bladder stones
- UTI, fever?

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8
Q

BPE Ex (5.)

A

**(1.) DRE: BPH is smooth enlarged prostate

**(2.) Genitals + Abdo Ex: palpable bladder?

**(3.) Neurological Ex: Is SC injury causing LUTs?

(4.) IPSS Questionnaire: Severity of Sx? Allows to monitor improvement, deterioration and QoL

(5) Flow-volume chart
- Filled by pt
- Monitor quantity, time and any incontinence

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9
Q

Ix of BPE (3)

A

Dx = BOO secondary of BPE, LUTS

(1. ) Urinalysis
- detect infection (leukocytes, nitrates)
- NVH
- glycosuria (metabolic problem?)
- Abnormal dipsticks require further tests e.g. cultures

(2. ) PSA
- implications should be discussed prior
- if +ve + DRE is +ve -> TRUS + biopsy

(3.) IPSS questionnarie

Consider

  • US
  • CT abdomen/pelvis
  • Uroflowmetry studies
  • Cystoscopy: if red flag sx, infection, stones, haematuria,
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10
Q

PSA - what is it? what must be considered? pros and cons?

A

(1. ) Prostatic Specific antigen is part of normal male physiology - its role is to liquify semen.
(2. ) Levels raised in = large prostate, infection, catheterization, prostate cancer, ejaculation
(3. ) Used with caution and should not be done routinely in Ix of BPH. PSA may be indicated where cancer is suspected (malignant feeling prostate, metastatic disease suspected)
(4. ) Informed Consent Testing, benefits and risks of PSA testing are explained

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11
Q

Tx of BPE (4)

A

(1.) WW and lifestyle advice: if Sx do not bother pt. Weight loss, reduce caffeine

(2. ) Medical interventions:
(a. ) 1st line: a-blocker (tamsulosin)
- prostate <30g, relaxes smooth muscle
(b. ) 5alpha-reductase inhibitor (finasteride)
- Inhibits testosterone to dihydrotestosterone
- reduces prostate size
(c. ) Combination may be used

(3.) AUR requires immediate catheterisation + urgent Tx

(4. ) Surgery: TURP
- If Tx fails, complications such as AKI, stones, haematuria

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12
Q

Aetiology, Sx, Tx of Acute Urinary Retention

A

(1. ) AUR is SUDDEN inability to pass urine.
(2. ) Aetiology = BPE, bladder stones
(3. ) Sx = unable to micturate, lower abdo or flank pain, swelling of bladder
(4. ) Tx = Catheter will relieve pressure on bladder and abdo

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13
Q

Complications of BPE

A
  • Urinary retention
  • Chronic retention
  • UTI (due to incomplete emptying)
  • Haematuria
  • Bladder calculi
  • Sexual dysfunction: On alpha blocker and 5-alpha reductase inhibitor
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14
Q

3 RF of Prostate Cancer?

A
  • Most common malignancy in men.
  • RF = Age (~70y), Fx, black ethnicity
  • Although there is a small trend, Fx as a RF is weak
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15
Q

Where does the cancer arise in prostate cancer? where can it metastasise? prognosis?

A

(1. ) It is an adenocarcinoma that occurs in the peripheral zone
(2. ) Metastatic spread:
- pelvic lymph nodes
- bone metastases (lumbar spine and pelvis)
- Lung, liver, brain (rare)
(3. ) 10-year survival rate from 95% to 10% (metastatic)

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16
Q

Clinical features of prostate cancer

A
  • Asymptomatic
  • LUTS are rare, more common in BPE
  • If metastases present: Back pain, weight loss, anaemia, obstruction of ureters
17
Q

Examination and Investigations of prostate cancer (5.)

A

(1. ) DRE
- Nodular, hard
- H/e in 45% tumour is not palpable

(2.) PSA level

Consider below…..

(3. ) Transrectal US + biopsy
- If abnormal DRE + PSA levels
- Gleason’s grading assess histology and aggressiveness

(4. ) Pelvic MRI, CT
- Once Dx is confirmed
- Can be used to confirm staging and involvement

(5. ) Bone scan
- If metastases is suspected, high PSA may indicate this

18
Q

Mx and Tx of Prostate Cancer (5)

A

(1.) Low grade = WW + Surveillance (PSA, DRE, biopsy)

(2. ) Intermediate Risk = Radial prostectomy or radical radiotherapy w/ anti-androgen drugs for 6m
- localised tumour and pt w/>10y life expectancy for surgery

(3.) High Risk = Radial prostectomy or radical radiotherapy w/ anti-androgen drugs for 3y

(4. ) Chemotherapy
- If fails to respond to endocrine Tx or disease improves & then comes back

(5.) Analgesic for bone pain

19
Q

RF for testicular cancer (8.)

A
  • 20-40y men
  • Cryptorchidism (undescended testes)
  • infant hernia
  • infertility
  • white Caucasians
  • Fx
  • HIV
  • Genetics: TGCT1 mutation
20
Q

What is testicular cancer and where does it arise from?

A

(1. ) Most common malignancy in young adult men + curable when diagnosed early.
(2. ) Hard, painless nodule on one testis
(3. ) Elevated serum markers aid dx and monitoring tx response: alpha-fetoprotein (AFP), beta-human chronic gonadotrophin (B-hCG)
(4. ) >95% of arise from germ cells: seminoma & teratoma. The remaining arise form leydig cells - usually small and benign, secretes oestrogen thus presents with gynaecomastia

21
Q

Staging of testicular cancer

A
  1. No metastases, no evidence of disease outside the testis
  2. Infradiaphragamatic node involvement (via para-aortic nodes)
  3. Supradiaphragmatic node involvement
  4. Lung, liver involvement
22
Q

Clinical features of testicular cancer (5.)

A
  • > RF present: young, mass, fx, cryptorchidism
    (1. ) Hard painless lump
    (2. ) Testicular +/- abdo pain
    (3. ) Dragging sensation
    (4. ) Gynaecomastia (leydig tumor)

(5. ) Look for involvement:
(a. ) Lymph involvement?
- Para-aortic nodes = back pain
- Abdominal mass/lump
(b. ) Metastases
- liver, lung, bone and brain.
- lung metastases = dyspnoea

23
Q

Investigations of testicular cancer (5.)

A

(1. ) 2ww referral - can be done following or prior to USS
(2. ) Scrotal US and doppler: confirms Dx
(3. ) CXR, CT or pelvis abdo: staging
(4. ) Serum tumour markers (beta-hCG, AFP)

(5. ) Inguinal orchiectomy
- confirm histological diagnosis is initial treatment in most cases.

24
Q

Management of testicular cancer

A

(1. ) Radical orchidectomy (complication: infertility)
(2. ) Chemotherapy if metastases
(3. ) Encourage self-examination
(4. ) Follow up: CT, assess AFP, b-hCG

Urology (9 decks)

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